David Macaray is a playwright and author ("How to Win Friends and Avoid Sacred Cows: Adventures in India")

MEDICAL DOCTORS AS ENTREPRENEURS

04/03/2017 01:37 pm ET

Years ago, the chief medical officer (“Dr. Smith”) of the company I used to work for addressed a group of union negotiators on the formidable topic, “How to lower medical costs.” Even though Dr. Smith was a respected M.D. he jokingly referred to himself as a “traitor” to his tribe, because it was his intention to reveal some not so complimentary facts about doctors.

His presentation focused on two opposing scenarios, both having to do with treating suspected pneumonia. The reason this malady was chosen as an example was because, according to Dr. Smith, pneumonia is (1) potentially fatal, and (2) in its early stages, it is usually quite easy to cure.

In Scenario A, a patient comes in with bad cough and a fever. A stethoscope applied to his chest indicates that his lungs are congested. Congestion, cough, fever. Can’t say for sure if it’s pneumonia, but clearly, it’s something that, if allowed to go untreated, could develop into pneumonia.

The doctor writes a prescription for 16 penicillin pills, tells the patient to take two a day, and to come back if there’s no improvement or if, at any point, the symptoms appear to be getting worse. Other than that, we’re finished here. The total cost to the patient is one office visit and one bottle of pills. That’s Scenario A.

In Scenario B, everything is more intensive. And more expensive. Dr. Smith noted that because so many doctors own outright (or in partnership) the on-site lab and X-ray facilities, it’s in their economic self-interest to utilize them as often as possible. After all, somebody has to pay for that high-tech equipment.

So the man with the congestion, fever and cough is required to have an X-ray. Dr. Smith argued that this procedure was very likely an unnecessary expense, insisting that whether or not the picture revealed water on the lungs, the patient would, in either case, receive the identical treatment. With or without X-ray confirmation, he would be prescribed the same penicillin pills. So why bother with an X-ray?

Moreover, in Scenario B the patient is told to return to the office after taking the 16 pills, even if he no longer has any symptoms, and even if he’s feeling great. You need to come back anyway. While they refer to this as a “follow-up” visit, Dr. Smith referred to it as a “rip-off,” as a way to harvest the additional cost of an office visit. Unnecessary X-rays and superfluous office visits. They add up.

Granted, because this was one company doctor talking—one man’s opinion, so to speak—we were unwilling to take everything he said as Gospel. Even though we were all mildly pissed off and a bit disillusioned by what he told us, we weren’t going to grab pitchforks and torches and storm the nearest medical complex. Still, we had to admit, his observations made sense.

But his closing remarks were disappointing and frustrating. What frustrated us was that Dr. Smith insisted a big part of lowering medical costs was our responsibility—the patients’ responsibility. He told us we needed to “challenge” these doctors whenever they appeared to be padding their bill. Challenge them. Argue with them. What made his remarks so “frustrating” was the fact that everyone in the room had to know that such a thing wasn’t going to happen.

It’s hard enough “arguing with” our auto mechanics, much less our doctors. Unlike Europe, where doctors are viewed as “scientists,” and are respected but not revered, we Americans tend to worship our doctors. We view them as god-like. I can almost understand why a brilliant brain surgeon would be lionized, but why a podiatrist? The miracle of corn and bunion removal? Please.